Jared Kent Wilson, PA-C, MPAS, MED, ATC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA-952 Issued in ID

Practice address

777 Hospital Way
South Mob, Suite 204
Pocatello, ID 83201-5175

Phone

(208) 239-2110

Fax

(208) 239-2119

NPI assigned

May 14, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pocatello Health Services LLCGroup PAC ID 6608927637, 171 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education, Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwilson179508@ahs.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pocatello Health Services, LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1689802852
  Medicare reassignment Care Compare group
• Pocatello Health Services, LLC

  • Durable Medical Equipment & Medical Supplies
  • Pocatello, ID
  • NPI 1154089126
  NPD
• Pocatello Hospital LLC

  • Internal Medicine Physician
  • Pocatello, ID
  • NPI 1760610935
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pocatello Hospital LLC

  dba Portneuf Rehabilitation Center

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Medical Center

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754179200000",
    "number": "1275748089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "address_2": "SOUTH MOB, SUITE 204",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-239-2110",
            "fax_number": "208-239-2119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "address_2": "SOUTH MOB, SUITE 204",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-239-2110",
            "fax_number": "208-239-2119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JARED",
        "middle_name": "KENT",
        "credential": "PA-C, MPAS, MED, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2025-08-03",
        "certification_date": "2025-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "AT-492",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ID",
            "license": "PA-952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Silas Angier Wills Jr., MD
• Teri Lee Wilske, LSW
• Jessica Michelle Wilson-Lucero, ED.S, NCSP
• Dakota Wilson, PA-C
• David Wilson, LCPC
• Olivia Wilson
• Patricia Ann Wilson, CNIM
• Brianna Dannielle Windhorst, LPC
• David Leo Wise, M.D.
• Kori Ann Wittrock, PHARMD

• Surgical Physician Assistant in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Surgical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.